Sanitas, a medical insurance and services company with 18 years in Venezuela and 200.000 plus paying customers is unable to meet its costs with the tariffs authorized by the govt , is now closing one by one each of its clinics and services , firing 400 of its 2.700 employees and is planning to close down all its operations by May of 2017.

A great many of the most reputable private clinics in Caracas are unable to meet their staffing and operating costs and are asking their physicians to put up the money to keep going , a big part of the problem is that insurances presumably responsible for paying the medical costs of many of their patients have stopped payments altogether , this include many insurance schemes protecting govt and Pdvsa employees ….!! Of the various medical practices the only one still basically unscathed s the surgical practice which even if the number of operations performed is substantially down , still maintains some level of activity …..

The whole Venezuelan private medical system is in crisis . The public system has been in ruins for years , the sad tragic story has been told many times thru articles published in all important international media . The story that’s next is how the financially battered private clinics are begining to fall of the cliff due to the ongoing crisis..!!

This is my humble attempt at translating the article, feel free to suggest and improve the translation:

“Looking at Marilyn’s face”

The life of the medicine intern, at least at its beginning, is reduced to trying not to get lost within the hospital. One gets ready to confront barging into the wrong room several times, always with a very serious face so no one notices how disoriented one is, until the assigned patient is found. And then, after getting through the periodic labyrinth, it was when I met Marilyn -To who I had to attend for several weeks.

A mountain of grayish curls that crowned her pillow and the face marked with wrinkles invited to gues her age was 60 when she was actually 49. That first time, I came tired after measuring a reluctant lady’s blood pressure and I wasn’t exactly feeling in the best disposition to attend “another lady”. Restraining my impatience I breathed deep and asked her for her arm to take her vital signs. Marilyn not only gave me her arm but she also opened like a diary. She wanted to talk.

“Look” She started, “Every time I take off the blanket, that lady at that side makes a bad face because of the smell.” Even when I wanted to answer her that, indeed, that lady was very cranky, I didn’t. “At ease, Mrs. Marilyn, there’s no smell”, I limited to answer just that. It was half of a lie, the hospital smells like a lot of stuff, but actually it is so much stuff that it’s hard to know what smells like what, specially in a room where there are four more patients.

Marilyn arrived to the hospital’s fifth floor after coming to emergency due to a vaginal hemorrhage. Though they managed to stabilize her, it was necessary a tomography (CT scan) so the surgeons could make a decision. At the hospital no CT scans have been performed since immemorial times, so the patients look for one private institution for the study.

After many days his son was honest: “We are going to do it, we have the place but we are waiting to get a turn for wednesday because that day’s cheaper… The thing is that we don’t have much money now” he added as it was his fault and an apology was needed. When the apology should actually come from all of us.

An apology not only for lacking a tomograph in a Type IV hospital, but because his mother’s hemorrhage was secondary to the cervical cancer that afflicted her. A disease unique in its kind: A perfectly preventable type of cancer, only an annual cytology was needed to detect the injuries caused by human papillome virus (HPV), its causing agent. Every time a woman gets cervical cancer it means that a series of failures in the health system got intertwined. A defead for which we all are responsible, the shame of not being able to guarantee to the women in this country such a simple, economic and quick test as a cytology.

I heard every gossip that Marilyn told about her roommates or the nurses, and I pondered about the long string of failures that came until arriving to the cervical cancer. The academic interest I had while analyzing her disease went away one fateful morning when I saw her puking leaden lava. It was the blood in the digestive tract that darkens before getting expelled.

But no, I’m no doctor nor I have anything for the pain. I only get uncertain assertions to give her and her family.

Even the staunchest student becomes shocked when she faces such a spectacle. “It’s the first time I see black puke” it’s the comment of some appeased companions, thoughtful, trying to limit the boundaries of the physiological implications of the situation and reducing the emotional distress when the image, tattoed by fire, comes back without permission. “Black like that notebook, like that bag, like that pen”, or anything at hand to signal with dread the terrible image they accidentally witnessed.

But Marilyn didn’t seem so worried about this as she was about other stuff. “Dr. Carla is very clueless, you know” she says as a little girl, “remind her to gime me something for the pain, doctor.”

But no, I’m no doctor nor I have anything for the pain. I only get uncertain assertions to give her and her family.

“I will ask for the analgesics, I will notify the specialist that you are in a lot of pain” I answered her. As if I didn’t actually know that we ran out of morphine, firmly pretending to believe that the medical orders that are sent from one place to another have any utility, that the unconnected whispers in every magazine will solve anything.

Because the edicts of the chance are ruthless, or maybe because the cancer is a mercyless and hostile competitor, it was just the day before her appointment for the CT scan when, between new heaves of dark and shimmering puke, the fight between Marilyn and her illness was allowed to be waged without further intervention.

We witnessed the terrible show trying to supress the dread, with darting looks and muffled whispers, avoiding to think that Marilyn’s defeat was our own defeat as professionals, as people, as a country. Trying to ease in the everyday life the chilling horror of acknowledging every morning, in the agonizing debacle of a woman, a whole country buried under the domain of the oil that drowns us until we are dead.

Trying to soften the brutal slap of watching ourselves reduced to a cancer without morphine, eternally sentenced to that empty gaze that drowns in a tide of black puke.